ارتباط مراقبه و نتیجه درمانی در شناخت درمانی مبتنی بر حضور ذهن برای اختلال دو قطبی

This study aimed to examine the impact of quantity of mindfulness meditation practice on the outcome of psychiatric symptoms following Mindfulness-based Cognitive Therapy (MBCT) for those diagnosed with bipolar disorder. Meditation homework was collected at the beginning of each session for the MBCT program to assess quantity of meditation practice. Clinician-administered measures of hypo/mania and depression along with self-report anxiety, depression and stress symptom questionnaires were administered pre-, post-treatment and at 12-month follow-up. A significant correlation was found between a greater number of days meditated throughout the 8-week trial and clinician-rated depression scores on the Montgomery-Åsberg Depression Rating Scale at 12-month follow-up. There were significant differences found between those who meditated for 3 days a week or more and those who meditated less often on trait anxiety post-treatment and clinician-rated depression at 12-month follow-up whilst trends were noted for self-reported depression. A greater number of days meditated during the 8-week MBCT program was related to lower depression scores at 12-month follow-up, and there was evidence to suggest that mindfulness meditation practice was associated with improvements in depression and anxiety symptoms if a certain minimum amount (3 times a week or more) was practiced weekly throughout the 8-week MBCT program.

According to Cahn and Polich (2006), meditation affects individuals at two levels. The first is through their immediate subjective state which occurs during the meditation practice itself and includes subjective experiences of calmness, peacefulness, a slowing or cessation of thoughts and increased perceptual clarity (Cahn & Polich, 2006). The second is at the trait level, which comprises accrued benefits of meditation practice over time. This includes changes in relationships to thoughts, feelings and internal experiences which, in turn, lead to the experience of a deeper sense of calm, sense of comfort and heightened sensory awareness outside the meditation practice (Cahn & Polich, 2006). Mindfulness meditation is one of the main components of Mindfulness-based Cognitive Therapy (MBCT) which was originally designed to treat patients with recurrent depressive episodes in order to prevent relapse (Segal, Williams, & Teasdale, 2002). MBCT comprises an 8-week group therapy program that combines cognitive therapy with the principles, concepts and mindfulness meditation exercises of the Mindfulness-based Stress Reduction (MBSR) program, originally developed by Kabat-Zinn (1990). Mindfulness meditation involves concentrating on the breath or body while maintaining a non-judgmental stance towards thoughts and feelings (Kabat-Zinn, 1990; Segal, Williams, et al., 2002). Mindfulness meditations in MBCT and MBSR include the Body Scan Technique – involving the non-judgmental observation of bodily sensations; the Sitting Meditation – observation of breathing in the abdominal region and any thoughts or feelings that arise; and the 3-min breathing space – a short meditation focussing on observing physical sensations, the breath and the body, in a non-judgmental way (Kabat-Zinn, 1990; Segal, Williams, et al., 2002). Greater frequency of practice of the Body Scan meditation has been found to be associated with lower anxiety and interpersonal sensitivity scores after an MBSR program (Carmody & Baer, 2008). Others examining MBSR have also noted correlations between greater time spent in meditation and lower somatization symptoms, higher self-rated health and lower psychological distress scores for pain patients (Rosenzweig et al., 2010). However, a review of twenty-four studies that assessed mindfulness meditation, home practice indicated that almost half of the studies did not find any associations between meditation practice and treatment outcomes (Vettese, Toneatto, Stea, Nguyen, & Jing Wang, 2009). For example, Ramel, Goldin, Carmona, and McQuaid (2004) found that quantity of meditation practice was unrelated to improvements in depression and anxiety symptoms following MBSR, whilst Carmody, Reed, Kristeller, and Merriam (2008) noted no relationship between frequency of home meditation practice and improvements in state or trait mindfulness, medical symptoms or psychological distress (Carmody et al., 2008). The assumption in many of these previous studies has been that greater quantities of meditation practice will be associated with greater improvements in psychiatric symptoms. An alternative hypothesis is that there is a minimum amount of meditation practice which is required to effect symptom improvements. One study has reported that participants who had engaged in a minimum of 3 days of mindfulness meditation practice a week during a modified MBSR program demonstrated significant increases in trait mindfulness scores compared to those who meditated for 2 days a week or less, at post-treatment and at 3-month follow-up (Schenstrom, Ronnberg, & Bodlund, 2006). However the relationship between meditation practice and other outcome variables such as overall well-being was not assessed (Schenstrom et al., 2006). Although some studies have examined the efficacy of MBCT as an adjunctive treatment for bipolar disorder (Weber et al., 2010; Williams et al., 2008), as yet no studies have examined the relationship of the quantity of mindfulness meditation practice to symptom improvements. This study aimed to assess the relationship of mindfulness meditation practice to symptom improvements following MBCT training in a sample of participants with bipolar disorder over a 12-month follow-up period. Full details of the methodology and results of this trial have been reported elsewhere (Perich, Manicavasagar, Mitchell, Ball, & Hadzi-Pavlovic, 2013). It was hypothesized that the more days engaged in meditation practice would be associated with corresponding increases in mindfulness (state and trait), lower hypo/mania, depression and anxiety scores at post-treatment and at 12-month follow-up. This study also aimed to replicate the results of Schenstrom et al. (2006) by examining the impact of a minimum amount of meditation practice per week (minimum of 3 days) on trait mindfulness and treatment outcome. It was hypothesized that those practicing meditation for a minimum of 3 days per week would return lower scores on depression and anxiety and higher scores on trait mindfulness than those who practiced 2 days a week or less.

This study suggested that the quantity of mindfulness meditation practiced throughout an MBCT program for bipolar disorder is related to lower depression scores at 12-month follow-up. There is also some evidence to suggest that mindfulness meditation practice is associated with improvements in depression and anxiety symptoms if a certain minimum amount (3 times a week or more) is practiced weekly throughout the 8-week MBCT program.